Laserfiche WebLink
APPLIGATI0h SITE APPROVAL <br /> PRIVATE RIGHT OF WAY-ANTIQUATED SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, the Owner/Agent agree, to defend,indemnify,and hold harmless the County and its agents,officers and employees from any claim,action or <br /> proceeding against the Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that I am(check one): <br /> Legal property owner(owner includes partner, trustee,grantor, or corporate officer)of the property(s)involved In <br /> A <br /> this application, or <br /> O Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and <br /> have been authorized to rile on their behalf.,and that the foregoing application statements are true and correct. <br /> Print Name: ` <br /> l�� f' Signature: �L hcz crl;,i �-'`��.-t�[ Date: <br /> Print Name: /)/I-/t Al 'tt Z_ L u /1 4•1 Signature: iUl1G �r / Date: <br /> Print Name: Signature: Date: <br /> Print Natne: Signature: Date: <br /> Print Name: Signature: Date: <br /> SITEAPPI,i PIANTIFORMDIVAPP REV.e-9-01 (IHD) <br /> -5- <br />